Among the criticisms against consumer-directed health plans (CDHP) is that they are merely a way to transfer costs onto patients, don't create more educated healthcare consumers, and force patients to delay preventive care.
It's up to health plans to prove those assumptions wrong. Aetna took a step in that direction by releasing a six-year study of its consumer-directed plan, called HealthFund. Aetna found that HealthFund members did not put off chronic and preventive care—and the plan actually helped make members better healthcare consumers.
Aetna is making that claim because HealthFund members used generic drugs, didn't utilize emergency rooms for basic care, and accessed online tools and information more often than Aetna's PPO members. The study also found sustained savings in the CDHP over that time period.
"What we were able to find is that we were able to sustain control of costs over time without sacrificing care," says Kathy Campbell, director of consumer-directed health plans for Aetna in Hartford, CT.
CDHPs often enjoy a first-year savings for employers when the new plan is offered, but Campbell says the study showed that the savings continued in succeeding years. Aetna, similar to many insurers, doesn't charge members for preventive care, which Campbell says removes cost barriers so members get the care they need to ward off future health problems.
The study found that Aetna HealthFund members accessed the same or higher levels of preventive, diabetes-related, and chronic care. Researchers also discovered that emergency room usage decreased for HealthFund members, which resulted in 5% to 10% lower emergency room use than the control group. Aetna said this shows members are not using the emergency room for non-urgent care and are getting the necessary preventive services.
Critics of CDHPs will surely point to the results and say it's simply a large insurer promoting its product. Regardless, health plans and employers can learn from Aetna's experience.
For instance, to find the employers that are effectively implementing consumerism practices, Aetna looked at 11 best-in-class customers, which included more than 144,000 employees.
The Aetna study found that best-in-class performers used five strategies for success:
- Promote a strategy where employers are engaged healthcare consumers
- Build a benefits package with appropriate member responsibility
- Engage employees
- Emphasize wellness and healthy behaviors
- Steer enrollment toward the Aetna HealthFund plan option
The best-in-class performers introduced coordinated strategies in the areas of benefit structure, information and tools, and a culture that fostered engagement, such as getting management to lead the effort through example.
"If the management team—and this is from the top-down— understands how important this is, it makes a difference. Also, engaging people so they enroll in the plans—that made a difference in the results," says Campbell.
The best in class also helped employees and their families make informed decisions to better manage their health, spending, and overall wellness through providing cost of care, benefits information, and the Aetna Navigator member Web site. Those employers also reduced employee premium contributions for those in HealthFund.
As employers search for ways to cut healthcare costs, CDHPs will remain a viable option. But employers and health plans must not look at CDHPs as merely a way to transfer costs onto the individual. That does not work and will only force members to put off vital care, both preventive and chronic.
Instead, health plans and employers should view CDHPs as a way to change the dynamic. This will take time as members have become accustomed to insurers taking on much of the decision-making responsibility.
Consumerism means member empowerment, but health plans and employers need to actually educate the individual. They can't merely create a Web site with a glossary of healthcare terms and set up an HSA. These stakeholders must also invest in member outreach and conduct lengthy education campaigns.
With a public insurance option close to becoming a reality, the future of health plans could be riding on the success of CDHPs.
Health insurers view CDHPs as a cost-saving, patient-empowering movement, as was evident in the health plan portion of the HealthLeaders Media Industry Survey 2009, but the percentage of employees enrolled in a CDHP is still often in the single digits in the small employer market. Large employers that have invested in CDHPs, however, are finding more interest.
In fact, the 14th annual National Business Group on Health/Watson Wyatt Employer Survey on Purchasing Value in Health Care found that 43% of large employers surveyed said they have more than 20% employee enrollment in a CDHP and the median enrollment has increased to 14% in the large employers surveyed.
The percentage of employees in CDHPs is important because getting more employees enrolled in those plans correlates with lower costs. In looking at cost trends and basic costs, Ted Nussbaum, group and healthcare practice leader at Watson Wyatt in Stamford, CT, says companies need 15% enrollment to begin seeing ROI that is required for building CDHP infrastructure. Companies with at least half of their employees enrolled in a CDHP have a two-year cost trend that is 25% lower than non-CDHP sponsors, according to the survey.
"We're starting to reach that [15%] threshold. Companies are working very hard to address the health status of their population and get their employees to get involved in the process themselves," he says.
Inching closer to that 15% threshold is a positive step, but health plans and employers cannot celebrate the milestone. They must continue to push to create more educated consumers and just as importantly invest in programs like waiving preventive care costs and implementing value-based insurance design so preventive care is free and those suffering from chronic disease don't face cost barriers to care and life-saving medications.
Rather than improving health and creating better consumers, plans that simply shift costs will result in sicker members down the road—and that will cost the healthcare system even more.